|
|
 |
HIPAA Edits - ICD-9 Procedure Codes
The new edits will check for the presence or absence of specific medical procedure codes reported at the claim level for inpatient or outpatient hospital services. |
These edits are being added in order to comply with the final Health Insurance Portability and Accountability Act (HIPAA) rule, which named the ICD-9-CM Volume 3 Procedure Codes (including The Official ICD-9-CM Guidelines for Coding and Reporting), as the HIPAA standard medical code set for inpatient hospital services, and the HCPCS/CPT codes as the HIPAA standard medical code set for physician services and other health care services (including outpatient hospital procedures).
With the implementation of these edits, Humana will:
- No longer accept outpatient hospital claims with ICD-9-CM Vol 3 procedure codes in either or both the Procedure Information segment (BQ) or Other Procedure Information (BR). Humana will follow the HIPAA standard medical code set of HCPCS/CPT codes for outpatient services. Humana's rejection message will state, "ICD-9 valid only for hospital inpatient bill types."
- No longer accept an inpatient hospital claim with a HCPCS/CPT code in either or both the Procedure Information segment (BP) or Other Procedure Information (BO). Humana's rejection message will state, "ICD-9 must be used for hospital inpatient reporting."
|
Humana.com Home
Explore Provider Self-Service Center
97.2KB - 